Hodgkin's Disease - Transplantation

The Blood Stem Cell Collection Procedure

The donor is usually given a drug called granulocyte colony-stimulating factor, or G-CSF (filgrastim, lenograstim) to stimulate stem cell growth.
The patient (or donor in an allogeneic procedure) then undergoes apheresis. With this process the blood is withdrawn from one of the patient?s veins, then passes through a machine that filters out the white cells and platelets, which contain the stem cells. The blood is returned through another vein. The entire procedure takes3 to4 hours but needs to be repeated several times.
The stem cells are treated to remove contaminants and then are frozen to keep them alive until the patient is ready to receive them back.

The Transplantation Procedure

Allogeneic transplants are preceded by chemotherapy treatment known as conditioning. The point of this treatment is to inactivate the immune system and to kill any residual malignant cells. It is extremely toxic since it also destroys non-malignant marrow cells.Drugs used are typically cyclophosphamide, carmustine, and etoposide. Alternative conditioning to reduce toxicity includes total-body radiation plus drugs.
A few days after treatment, the patient is rescued using the stored stem cells, which are administered through a vein. This may take several hours. Patients may experience fever, chills, hives, shortness of breath, or a fall in blood pressure during the procedure.
The patient may be treated with granulocyte colony-stimulating factor after chemotherapy. The goal is to stimulate the growth of infection-fighting white blood cells. Because this increases immune factors, there is some concern that it might also heighten the immune attack against the donor cells, but studies to date have been encouraging and are reporting a low risk. (Adding another substance, thrombopoietin, may prove to enhance stem cell production.)
The patient is kept in a protected environment to minimize infection, and he or she usually needs blood cell replacement and nutritional support.

Candidates and Success Rates

Patients with advanced or relapsed Hodgkin's disease, particularly for young patients with a poor outlook, may benefit from stem cell transplantation. Some studies suggest benefits using stem cell transplantation for early-stage patients who do not respond to initial therapy. This includes those who achieve an initial partial remission, those who progress during therapy, and those who have evidence of residual disease on biopsy.

Patients with who are in poor condition at the time of the transplantation are more likely to experience poorer results.